Perioperative Anaphylaxis: Recognition and Management

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Class A Credits: 1.0

Format: Video

Run time: 63 mins

Course Launch Date: 1/17/20

Course Expires: 1/26/23

Anaphylaxis, is a severe hypersensitivity reaction that can be fatal if not recognized promptly and treated appropriately. Nationally, perioperative anaphylaxis accounts for 19% of all surgical complications. When encountered in the operating theater, its severity is worse than any other setting with a mortality rate up to 6%. The diagnosis is difficult to make during anesthesia given an unconscious patient that is covered and draped. Common signs and symptoms such as skin manifestations and difficulty breathing are not readily apparent in the anesthetized patient. Other symptoms of anaphylaxis such as hypotension and vasodilation are also often mistaken for side effects of intravenous and inhalational anesthetics. It is usually not recognized until the patient has had refractory hypotension despite large amounts of phenylephrine and ephedrine. Currently, the most common causes of perioperative anaphylaxis are antibiotics and paralytics. Newer agents such as sugammadex are also on the rise with presentation later in the perioperative period. Mitigating risk factors and optimizing control of comorbid conditions are critical to limit potential mortality. Although, the first line treatment is epinephrine, anaphylaxis still continues to be inappropriately treated by many providers with diphenhydramine and corticosteroids. 

The American Association of Nurse Anesthetists is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.

AANA is an approved provider by the California Board of Registered Nursing, CEP #10862.

Post-Test Attempt Notice
A minimum passing score of 80% is required to pass this course. You have TWO opportunities to achieve a passing score. If you fail to achieve a passing score of 80%, you will not receive CE credit for this course.

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  • Define anaphylaxis and understand the pathophysiologic mechanism during the perioperative period.
  • Recognize and describe clinical features associated with perioperative anaphylaxis.
  • Describe the management and treatment measures for perioperative anaphylaxis.

Cheryl Carr, MS, CRNA

Clinical Staff CRNA - Veterans Health Administration

Cheryl Carr is a combat army veteran of OIF (Operation Iraqi Freedom) who graduated with the top honors from the Keck School of Medicine CRNA program at USC in 2010. She currently teaches SRNA students and practices at the VA Hospital in Long Beach, CA. She is also the President Elect for the Alliance of the American College of Allergy Asthma and Immunology, (a professional society representing over 4,000 Allergist and Immunologists in the United States) and has a special interest in perioperative anaphylaxis for which she has been an invited speaker and expert on the topic.